The Manifestations of Skin Lesion on COVID-19 Patients: A Systematic Review

Main Article Content

Monica Trifitriana
Rido Mulawarman
Yuli Kurniawati

Abstract

Introduction: The 2019 Coronavirus Disease (COVID-19) is a respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that spread rapidly worldwide through human-to-human transmission. Skin is one of the target organs that involvement in adults and children affected by the novel coronavirus SARS-CoV-2. Despite the pathophysiologic mechanisms of cutaneous manifestations still unclear.


Objective: We aim to assess the latest evidence of skin lesions associated with Covid-19 patients with a detailed analysis of skin morphology for early diagnosis and lead to possible better prognosis in COVID-19 patients.


Method:  We performed a comprehensive search on topics that assessed the manifestations of skin lesions in Covid-19 Patients from inception until February 2022. 


Result: There were 25 studies out of a total of 2450 patients divided into six patterns of skin lesions that occur in the presence of COVID-19 infection, including maculopapular, urticarial, pseudo-chilblain, vesicular, petechiae/purpura and livedoid. Among these skin lesions, maculopapular and pseudo-chilblains lesions appear to be the most common, followed by urticarial, vesicular, livedoid, and petechial/purpura. These lesions have been found in people of all age groups, including children.


Conclusion: In conclusion, this systematic review supplied a complex and detailed analysis of 6 central dermatology patterns common in COVID-19 patients explaining the underlying molecular mechanisms. Another future study on cutaneous manifestations related to COVID-19 is still needed for detailed analysis.

Article Details

How to Cite
Trifitriana, M., Mulawarman, R., & Kurniawati, Y. (2023). The Manifestations of Skin Lesion on COVID-19 Patients: A Systematic Review. International Journal of Medical Science and Clinical Research Studies, 3(11), 2777–2792. https://doi.org/10.47191/ijmscrs/v3-i11-45
Section
Articles

References

Guo YR, Cao QD, Hong ZS, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak -an update on the status. Mil Med Res. Mar 13 2020;7(1):11

Abouhashem AS, Singh K, Azzazy HME, Sen CK. Is Low Alveolar Type II Cell SOD3 in the Lungs of Elderly Linked to the Observed Severity of COVID-19? Antioxid Redox Signal. Jul 10 2020;33(2):59-65.

Wang C, Worswick S. Cutaneous manifestations of COVID-19. Dermatology Online Journal. 2021;27(1).

Molaee, H., Allahyari, F., Emadi, S. N., Radfar, S., & Razavi, Z. (2021). Cutaneous manifestations related to the COVID-19 pandemic: a review article. Cutaneous and Ocular Toxicology, 40(2), 168–174.

Guervilly C, Bonifay A, Burtey S, et al. Dissemination of extreme levels of extracellular vesicles: tissue factor activity in patients with severe COVID-19. Blood Adv 2021;5:628–634.

Rongioletti F, Ferreli C, Sena P, Caputo V, Atzori L. Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns. Clinics in Dermatology. 2021;39(1):149-162.

Xue X, Mi Z, Wang Z, Pang Z, Liu H, Zhang F. High Expression of ACE2 on Keratinocytes Reveals Skin as a Potential Target for SARS-CoV-2. J Invest Dermatol. May 23 2020.

Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. Apr 30 2020;382(18):1708-1720.

Almeida G, Arruda S, Marques E, Michalany N, Sadick N. Presentation and Management of Cutaneous Manifestations of COVID-19. Journal of Drugs in Dermatology. 2020;20(1):76-83.

Askin O, Altunkalem RN, Altinisik DD, Uzuncakmak TK, Tursen U, Kutlubay Z. Cutaneous manifestations in hospitalized patients diagnosed as COVID-19. Dermatol Ther. Jun 24 2020.

Rodriguez-Cerdeira C, Uribe-Camacho B, Silverio-Carrasco L, Méndez W, Mahesh A, Tejada A et al. Cutaneous Manifestations in COVID-19: Report on 31 Cases from Five Countries. Biology. 2021;10(1):54.

Dalal A, Jakhar D, Agarwal V, Beniwal R. Dermatological findings in SARS-CoV-2 positive patients: An observational study from North India. Dermatol Ther. Jun 16 2020:e13849.

De Masson A, Bouaziz JD, Sulimovic L, et al. Chilblains is a common cutaneous finding during the COVID-19 pandemic: A retrospective nationwide study from France. J Am Acad Dermatol. May 4 2020.

Docampo-Simón A, Sánchez-Pujol MJ, Juan-Carpena G, et al. Are chilblain-like acral skin lesions really indicative of COVID-19? A prospective study and literature review. J Eur Acad Dermatol Venereol. May 26 2020.

Fattori A, Cribier B, Chenard M, Mitcov M, Mayeur S, Weingertner N. Cutaneous manifestations in patients with coronavirus disease 2019: clinical and histological findings. Human Pathology. 2021;107:39-45.

Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. Jul 2020;183(1):71-77.

Herrero-Moyano M, Capusan TM, Andreu-Barasoain M, et al. A clinicopathological study of eight patients with COVID-19 pneumonia and a late-onset exanthema. J Eur Acad Dermatol Venereol. May 19 2020.

Marzano A, Genovese G, Moltrasio C, Gaspari V, Vezzoli P, Maione V et al. The clinical spectrum of COVID-19–associated cutaneous manifestations: An Italian multicenter study of 200 adult patients. Journal of the American Academy of Dermatology. 2021;84(5):1356-1363.

Reymundo A, Fernáldez-Bernáldez A, Reolid A, et al. Clinical and histological characterization of late appearance maculopapular eruptions in association with the coronavirus disease 2019. A case series of seven patients. J Eur Acad Dermatol Venereol. Jun 4 2020.

Rubio-Muniz CA, Puerta-Peña M, Falkenhain-López D, et al. The broad spectrum of dermatological manifestations in COVID-19: clinical and histopathological features learned from a series of 34 cases. J Eur Acad Dermatol Venereol. Jun 11 2020.

Bouaziz JD, Duong T, Jachiet M, et al. Vascular skin symptoms in COVID-19: a french observational study. J Eur Acad Dermatol Venereol. Apr 27 2020.

De Giorgi V, Recalcati S, Jia Z, et al. Cutaneous manifestations related to coronavirus disease 2019 (COVID-19): A prospective study from China and Italy. J Am Acad Dermatol. May 19 2020.

Gaspari V, Neri I, Misciali C, Patrizi A. COVID-19: how it can look on the skin. Clinical and pathological features in 20 COVID-19 patients observed in Bologna, north-eastern Italy. J Eur Acad Dermatol Venereol. Jun 3 2020.

Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. May 2020;34(5):e212-e213.

Yildiray Y, Ayse P. Cutaneous manifestations of coronavirus disease in Turkey: A prospective study. Dermatologica Sinica. 2021;39(2):74.

Andina D, Noguera-Morel L, Bascuas-Arribas M, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol. May 2020;37(3):406-411

Colonna C, Genovese G, Monzani NA, et al. Outbreak of chilblain-like acral lesions in children in the metropolitan area of Milan, Italy, during the COVID-19 pandemic. J Am Acad Dermatol. Jun 10 2020.

Duong TA, Velter C, Rybojad M, et al. Did Whatsapp((R)) reveal a new cutaneous COVID-19 manifestation? J Eur Acad Dermatol Venereol. Apr 24 2020.

El Hachem M, Diociaiuti A, Concato C, et al. A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection. J Eur Acad Dermatol Venereol. May 31 2020.

Fernandez-Nieto D, Jimenez-Cauhe J, Suarez-Valle A, et al. Characterization of acute acral skin lesions in nonhospitalized patients: A case series of 132 patients during the COVID-19 outbreak. J Am Acad Dermatol. Jul 2020;83(1):e61-e63.

Freeman EE, McMahon DE, Lipoff JB, et al. Pernio-like skin lesions associated with COVID-19: a case series of 318 patients from 8 countries. J Am Acad Dermatol. May 29 2020.

Garcia-Lara G, Linares-González L, Ródenas-Herranz T, Ruiz-Villaverde R. Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak. Dermatol Ther. May 6 2020:e13516.

Magro C, Mulvey JJ, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. Jun 2020;220:1-13.

Cordoro KM, Reynolds SD, Wattier R, McCalmont TH. Clustered cases of acral perniosis: Clinical features, histopathology, and relationship to COVID-19. Pediatr Dermatol. May 2020;37(3):419-423